Raynaud’s disease

Background

Exaggerated vascular response to cold or emotional stress

Clinical Features

Sharp demarcated color changes of the skin of the digits
Pain, loss of sensation, and if recurrent ischemia may cause ulcers

Differential Diagnosis

• Primary (Raynaud disease or idiopathic Raynaud Phenomenon)
  • Symptoms without an associated disorder
• Secondary (associated with another illness, i.e. SLE or Scleroderma)

Evaluation

• Assess for digital ischemia
• Consider evaluation for underlying disorder

Management

Improve quality of life and prevent ischemic tissue injury

• Patient education on trigger avoidance
• Severe cases/Ischemia
  • Pharmacologic
    • Oral vasodilators
      • Nifedipine 30 to 180 mg/day
      • Amlodipine 5 to 20 mg/day
    • Topical nitrates
    • Phosphodiesterase 5 inhibitors
  • Surgical sympathetic blockade

Disposition

Patient with digital ischemia not responsive to oral or topical vasodilators may need anticoagulants, IV prostanoids, and sympathectomy

See Also

• SLE
• Scleroderma